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Uptodate Reference Title
Algorithm for growth hormone therapy in children
Algorithm for growth hormone therapy in children
This algorithm describes the author's approach to adjusting GH dosing for patients with GH deficiency. The optimal protocol for IGF-1-based GH dosing has not been established, and various protocols are used. Guidelines from the Pediatric Endocrine Society suggest dose adjustment for patients with high IGF-1 levels but do not specify the other dose adjustments outlined above for GH deficiency, because data on adult height outcomes after IGF-1-based dosing are not available[1].
GH: growth hormone; IGF-1: insulin-like growth factor 1; SD: standard deviation. * For most patients, we start at the higher end of this range, at approximately 35 micrograms/kg/day (0.24 mg/kg/week). For patients with severe GH deficiency, we use a lower starting dose of approximately 20 micrograms/kg/day because these individuals are more sensitive to the drug. ¶ For monitoring GH therapy, target range for IGF-1 is the upper one-half of the normal range (ie, IGF-1 0 to +2 SD). IGF-1 levels below this target range are associated with subnormal growth response to therapy; IGF-1 levels above this target range (ie, >+2 SD) may be associated with possible adverse effects of GH. Δ If GH is increased to >0.3 mg/kg/week but IGF-1 levels remain low (<–1 SD) despite good adherence to therapy, the patient may have GH insensitivity. If such patients also fail to have an appropriate growth response to GH therapy, the possibility of a GH insensitivity syndrome should be explored (refer to relevant UpToDate topic review). ◊ The growth response is typically considered adequate if the height velocity increases to above the 75th percentile for the child's age and gender during the period of "catch-up" growth. Refer to UpToDate topic text for details. § In patients with a comorbid disease that contributes to or causes the short stature, IGF-1 levels vary depending on the nutritional status but are typically below the normal range or in the low end of the normal range.
Reference:
Grimberg A, DiVall SA, Polychronakos C, et al. Guidelines for Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents: Growth Hormone Deficiency, Idiopathic Short Stature, and Primary Insulin-Like Growth Factor-I Deficiency. Horm Res Paediatr 2016; 86:361.
